Overcoming the Disconnect between Desired Outcomes and Educational Design

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Overcoming the Disconnect between Desired
Outcomes and Educational Design

• MODIFYING THE CURRICULUM TO ADDRESS MAJOR HEALTH
  PROBLEMS
• John Horton, M.B., Ch.B.
• Professor of Oncology and Medicine
• USF College of Medicine and Moffitt Cancer Center

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• A case in point
• Designing medical education about
• CANCER

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Modifying the Curriculum to Address Major Health
ProblemsFocus on Cancers

• Chief cancer killers (USA)
• lung, breast, colorectal
• Well-controlled cancer (USA)
• cervix uteri
• for discussion

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Interventions known to minimize mortality and
morbidity

• Example 1 lung cancer
• smoking prevention
• smoking cessation
• cessation maintenance
• and cardiovascular and pulmonary diseases

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Interventions (continued)

• Example 2 Breast cancer
• screening and early diagnosis
• -clinical examination
• -mammography
• Example 3 Cervix cancer
• screening with cervical cytology

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• Example I
• Lung Cancer Population Needs
• Smoking prevention (eg. schools)
• Smoking cessation
• Cessation maintenance
• Achieved by
• Public health policies
• Physician interventions

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Status of Physician Education regarding smoking
cessation 1980s a. Comfortable with
advising smokers to quit 4 b. Medical
schools with curriculum content on smoking
cessation 13
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Curriculum content/experiences required to
develop competency in smoking prevention/cessation

• Epi, biology, pathology, clinical manifestations
  of smoking-related diseases
• Addiction science
• Pharmacology (eg. Nicotine, SSRIs)
• Behavior modification science
• Experience in smoking cessation clinics
• Systems for recognition/implementation (eg. 40
  of breast cancer pts. are smokers!)

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Continuous Curriculum Review Process Assessment
of Current USF Curriculum Satisfactory a ?
d. Inadequate e cessation clinics f
- systems for recognition/ implementation
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Response by USF Curriculum a ?
d Continue e Elective in development f
Plans still pending
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Example 2 Breast Cancer Population
Needs Population screening and
early diagnosis Treatment Follow-up/symptom
control for discussion
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Competencies needed by general physicians to
address breast cancer mortality and morbidity a.
Understand the biology and clinical
manifestations of breast cancer b. Perform
risk-assessment history and adequate breast
examination c. Follow guidelines for
mammography d. Participation in a
systems-approach to ensure compliance to
screening guidelines e. Refer patients for
diagnosis and treatment
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Continuous Curriculum Review Assessment of
current USF curriculum a. OK b.
Improvements being instituted c. OK d. no
formal activity
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Example 3 Carcinoma of Cervix Uteri 1. Key
for control is population screening with
cervical cytology 2. Invasive cervical
cancer is now a rare disease in screened
populations in the USA and Europe 3.
Exceptions when poor compliance or lack of
insurance
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Carcinoma of the Cervix in Poland 1950-1975 deat
h rates decreasing 1975-1990 death rates
increased change in public policy.
Gynecologists read pap smears themselves
Note exception in 1 county where central
cytology review was maintained
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• Conclusions
• Define key health problems and choose which to
  address.
• Define ideal physician behavior/activity to
  address the problem
• Evaluate the current curriculum to determine if
  it provides the needed competencies for the
  medical graduates.
• If not, identify the deficiencies and implement
  modifications in the curriculum.